ACG’s very first “MACRA Tidbit for the Week” discussed the potential problems with MIPS and whether there was actually an opportunity to receive the bonuses as marketed by the Centers for Medicare and Medicaid Services (CMS) and policymakers.  The tidbit was called “MIPS or The Other Guy Must Fail First” Payment System.

CMS recently released data on MIPS participation and payment adjustments rates.  The data confirms this problem ACG highlighted back in 2016, where we must have clinicians who fail in order to provide bonuses to others.  The data also confirm ACG’s concern that MIPS would negatively impact smaller practices.  Thus, ACG has focused on increasing the exemptions from MIPS, as well as educating members on avoiding a payment cut rather than planning for those bonuses as promoted by Congress and CMS  As the cuts in MIPS get higher, however, ACG members should be ready to not only avoid these cuts, but also should be prepared to capture the bonuses provided by others’ payment cuts. ACG continues to educate and advocate on behalf of small and independent GI practices.

Some highlights from the CMS report:


This exceeded CMS’ goal of having 90% of MIPS-eligible clinicians participate during the 2017 performance year.


According to CMS, these data indicate that group reporting seems to be the preferred option for participating in MIPS.


According to CMS, “it is worth nothing that the participation rate for clinicians in small practices was higher in MIPS than under the previous legacy programs.”

2019 PAYMENT ADJUSTMENT RATES (based on 2017 reporting year)

Out of the 1,057,824 clinicians eligible for MIPS in 2017, 93% received a positive payment adjustment or better. Only 5% of MIPS-eligible clinicians received a negative payment adjustment in 2019 based on their 2017 reporting.

Of note, however, the highest payment adjustment applied in the 2019 Medicare payment year (based on 2017 performance) is 1.88%. What’s more, this 1.88% bonus includes the additional adjustment for exceptional performance. MIPS-eligible clinicians who did not receive an additional adjustment for exceptional performance (i.e. had a final score of 3.01 to 69.99 points) received a meager 0.20% bonus in 2019.

Small and Rural Clinicians: Final Score and Payment Medicare Adjustments

In 2017, 74% of MIPS-eligible clinicians in small practices received a positive payment adjustment compared to 93% of MIPS-eligible clinicians in rural practices.

What is more disconcerting to ACG is that 19% of small providers and 6% of rural providers were hit with payment cuts.  Thus, small and rural providers make up a good portion of the overall percentage (5%) of MIPS-eligible providers receiving cuts in 2019.

MACRA Year 3: Background and Acronyms

ACG’s goal is to provide membership with educational guidance in a simple, easy-to-understand fashion.  We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup, including acronyms such as MACRA, QPP, MIPS, APMs, etc. – but hopefully in a simplified fashion and in plain English.

Click here to check out our review of Year 3!